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Significant changes are occurring in the landscape of abortion provision in the UK. More women are having medical abortions and self-managing these at home, resulting in an increase in the proportion of abortions performed before 10 weeks’ gestation.1 Since 2018, women in Britain have been able to take misoprostol, the second medication for medical abortion, at home provided they have attended a clinic to have it prescribed. The COVID-19 pandemic has accelerated the trend towards self-management. As an emergency and temporary measure due to concerns about reduced health service access for women with unwanted pregnancies during the pandemic, consultations about pregnancy options have occurred by telephone or video and, if women wish and are deemed clinically appropriate, a medical abortion pack of both mifepristone and misoprostol can be posted to their home (up to 9 weeks, 6 days’ gestation in England and Wales, and no restriction in Scotland, but clinical guidelines state up to 11 weeks, 6 days). Laws prohibiting abortion have been repealed in Northern Ireland, effectively decriminalising most abortions, and pressure for decriminalisation has been mounting in the rest of the UK. The changes are taking place alongside shifts in thinking about healthcare generally. Recognition of patient-centred approaches and supported self-management, alongside enhancement of activities that complement clinical care in sexual and reproductive health, has gained more prominence.
The changes have significant implications for all methods of abortion …
Collaborators Other members of the SACHA Study Team not identified by name in the author list: Annette Aronsson (Karolinska University Hospital), Paula Baraitser (King’s College Hospital), Sharon Cameron (Lothian Health Board), Caroline Free (LSHTM), Louise Keogh (University of Melbourne), Maria Lewandowska (LSHTM), Patricia Lohr (BPAS), Rebecca Meiksin (LSHTM), Clare Murphy (BPAS), Wendy Norman (University of British Columbia), Rachel Scott (LSHTM), Sally Sheldon (University of Kent) and Geoff Wong (University of Oxford).
Contributors RSF drafted the article and JS, MJP, JR and KW contributed to subsequent drafts. All members of the SACHA Study Team were sent the final draft and provided comments.
Funding The SACHA Study (https://www.lshtm.ac.uk/research/centres-projects-groups/sacha) is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (NIHR Ref. No. NIHR129529).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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